Healthcare Provider Details

I. General information

NPI: 1659362929
Provider Name (Legal Business Name): GRAEME DONALD FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 VETERANS MEMORIAL DRIVE
MOUNT VERNON IL
62864
US

IV. Provider business mailing address

6 SANDY RIDGE RD
STERLING MA
01564-2362
US

V. Phone/Fax

Practice location:
  • Phone: 618-241-7016
  • Fax:
Mailing address:
  • Phone: 978-422-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number036-115830
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number152515
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD2025-0590
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: